Top Surgery and Lactation: What Do We Know?
It has long been lore in the trans pregnancy community that pregnancy might impact the results of top surgery, causing “puckering” that might require postpartum visits to the surgeon to correct. And there have certainly been news stories featuring trans men nursing their babies.
But what does the data say on these two questions? Let’s dig into what we know (and don’t know) about lactation’s impacts on top surgery results, and whether it’s possible to nurse one’s baby if you’ve already had top surgery.
To start with, let’s talk about language. Studies show (well, one study shows) that there is no agreement within the trans community about what language gets used when it comes to lactation. Some people say “nursing,” but that gets confusing because nursing is also a medical profession. Others say “chest feeding,” but often, providers don’t know what that means so it causes barriers to understanding. Many still say “breastfeeding,” conceding that cis men have breast tissue so it isn’t necessarily a gendered word. Finally, some of us just make up new words that work for us, like “mammal feeding”!
In this article, to avoid using language that is too triggering for folks, we’ll use “nursing” to describe the act of feeding an infant using one’s body. Feel free to mentally replace that word with the best one that works for you!
The Impact of Pregnancy on Top Surgery Results
According to one of the very few studies we have on lactation and trans pregnancy (thanks to Trevor MacDonald!), pregnancy can change the look and feel of a chest after top surgery, both temporarily and permanently. During pregnancy, mammary tissue that was left behind during surgery can respond to pregnancy hormones and regrow.
It’s important to understand that the study we’re referencing, while groundbreaking in its existence, only looked at nine trans people who’d had top surgery prior to pregnancy. So the numbers are small! But the study found that six of the nine participants had some degree of chest tissue regrowth during pregnancy, ranging from minor growth to their pre-surgery size. They also reported tenderness in that chest tissue, which was temporary and went away after giving birth.
It’s also possible for scars and/or skin to stretch, for chest contouring (shape) to shift (just like how pregnancy can change any body tissue as weight and hormone levels shift), and for nipple and scar color to darken. Some study participants found that these changes were temporary, while others reported that those changes went away during the postpartum period.
Many of these changes are more likely to be lasting/permanent if you pursue lactation, and many go away more quickly upon resumption of testosterone. Some people accept permanent changes as part of the changes that all bodies go through during a pregnancy process, while others pursue surgical revisions.
Lactation Post-Top Surgery
Lactation after top surgery is sometimes possible, but supply is often limited
In his two studies on trans lactation, Trevor MacDonald found that some transmasculine individuals do produce milk after chest masculinization surgery, but if you’d had top surgery of any kind, you’re unlikely to make enough milk to solely feed your baby using your own milk. To increase your supply and to ensure that your baby receives all the nutrients they need, supplementation (using an at-chest supplementer and/or formula/donor milk) is usually needed.
What that means in real life: “Possible” may look like anything from a few drops/comfort nursing to partial milk supply, rather than reliably making a full supply.
There doesn’t seem to be much correlation between types of top surgery and amount of milk produced, which is a fancy way of saying that there is no way of knowing how much milk, if any, you’ll produce!
What’s the TL;DR?
Tissue may or may not regrow in pregnancy
Nursing your baby may be possible if there’s enough tissue for a comfortable latch
To increase supply and ensure enough nutrients for your baby, you may benefit from at-chest supplementers and formula or donor milk
Some Additional Health Concerns to Note
If you’re pregnant/postpartum and notice rapid swelling, hot/red areas, fever, flu-like symptoms, or a new hard lump, get evaluated right away (mastitis/abscess is treatable, and new masses should be checked).
Prenatal planning helps: if there’s any chance you might lactate or want to attempt chestfeeding, lining up lactation support early is recommended because experiences after top surgery are highly variable.
Binding during pregnancy/postpartum: many people find binding becomes uncomfortable and less effective as pregnancy progresses, and tight compression postpartum can increase risk of plugged ducts/mastitis, whether you plan to lactate or not.
